In opposition, Andrew Lansley won plaudits from Conservative strategists for successfully ‘keeping the NHS quiet,’ a key element of David Cameron’s strategy to detoxify the Conservative brand. However since the election Number 10 has learnt that this strategy doesn’t work for governing parties. In truth, this is only partly about the reforms. A combination of a harsh winter, flu and the slowdown in spending was always going to be enough to turn up the volume in health.
So David Cameron may have pledged to stop, listen and reflect on the Government’s health reforms. Yet, judging by the last few days, the pause in the Health and Social Care Bill looks set to be anything other than a period of quiet reflection. After a seemingly endless round of consultations on aspects of the proposed reforms, we now have a new listening exercise and yet more consultation. It remains to be seen how much listening will be done, but the one thing that is certain is that many different interest groups will be doing a lot of shouting. This particular pause could be very noisy indeed.
Set this against the current situation in the NHS where implementation of many aspects of the reforms is underway. Pathfinder consortia, which are at the frontline of the reforms, are forming, identifying priorities and beginning to effect change, as demonstrated by our new report, The path to GP commissioning.
This week I attended a meeting of leading members of a consortium in a deprived area of outer London. The purpose was to identify changes which could be made to improve the consortium’s (by no means poor by national standards) record on diagnosing cancer at an early stage, which will be a critical test of whether the reforms will indeed improve outcomes. The members – who have never displayed a special interest in cancer before – were brimming with enthusiasm, ideas and commitment to deliver improvements. Their determination to take a population-based approach to encouraging early diagnosis was inspiring and their focus on immediate and practical action suggests that they will be able to drive improvements in outcomes. Equally, their professionalism, realism and determination to control costs gave me hope that the much feared loss of financial control will not occur in this part of London.
Not all consortia may be as impressive as the one I visited. Even if they are, this will not be enough to assuage some commentators’ concerns about other aspects of the reforms. Yet I was left thinking that if more people could see some of the changes which were afoot in this part of London then perceptions of the reforms may be quite different. What this consortium is doing could be revolutionary yet its members are far from filled with revolutionary fervour: they see an opportunity to do their jobs more effectively and they are determined to take it. In fact, there was an instinctive reaction against politics (of the party or medical variety) whenever the subject was mentioned.
The challenge for the Government is that, when the reforms are about ‘liberation,’ it cannot point to national change to demonstrate the impact of its policies. There is no equivalent of 18 weeks, 20,000 new nurses or 4 hours in A&E for these reforms. Instead, the progress will be local. The communications opportunity is in highlighting the local fruits of reform, such as championing the impressive changes afoot which I witnessed earlier this week. The communications challenge is that the Department of Health needs to find these examples (and fast) and persuade them to stand up and be exemplars. This may not be easy given the determination of many just to quietly get on with the job and the instinctive wariness of national politics which clearly exists.
The conundrum for the Government is that, although most people’s perception of health services is shaped by local experiences, the narrative around health reform is conditioned at a national level and the two do not always align. If these reforms are to work then the Government needs to find a way of getting the local to shape the national: the quiet revolution will need to trump the noisy pause.